Severe Acute Respiratory Syndrome in Children

Lauren J. Stockman, MPH*†; Mehran S. Massoudi, PhD, MPH*; Rita Helfand, MD*; Dean Erdman, DrPH*; Alison M. Siwek, MPH*†; Larry J. Anderson, MD*; Umesh D. Parashar, MD, MPH*

Disclosures

Pediatr Infect Dis J. 2007;26(1):68-74. 

In This Article

Prognosis and Outcome

To date, no fatal cases of SARS have been reported among children, and compared with adults the disease appears to be milder in children younger than 12 years of age. In the 135 cases we reviewed, the only patient younger than 12 years of age who required intensive care was a premature infant, born at 30 weeks of gestation and hospitalized at 8 weeks of age, who was managed successfully with continuous positive airway pressure.[20] Sore throat, high neutrophil count at presentation and peak neutrophil count of >10,000 cells per mL of blood have been found as independent predictive factors for severe illness in terms of requirements for oxygen and intensive care, regardless of the patient's age.[16] Radiographic changes have been found to resolve more quickly in children than in adults,[8] although opacities may require 1 month before returning to normal for the most severely affected children.[21]

The outcomes in children up to 6 months after disease onset, including exercise tolerance, pulmonary function and psychologic status, have been favorable.[16,22] In 1 study that examined radiographic and pulmonary function outcome in 47 children with SARS at 6 months after illness, mild abnormalities were detected by high resolution computerized tomography and pulmonary function testing in 34 and 11% of patients, respectively.[22]

One report has described osteonecrosis in children who received steroids as part of a treatment regimen for SARS.[23] Although osteonecrosis has been a recognized risk of corticosteroid treatment of other pediatric illnesses including lymphoblastic leukemia,[24,25] the clinical significance and causality of this outcome with SARS are not well-established. For example, Chan et al conducted magnetic resonance imaging on 11 children with SARS and found evidence of osteonecrosis affecting multiple bones in 45% of patients, although all of these patients were free of symptoms of osteonecrosis. In addition, all of these children had been treated with prednisolone, and it is unclear whether the complication was associated with treatment or with the SARS illness. There are similar reports of osteonecrosis and avascular necrosis in follow-up studies of adult patients with SARS who were treated with corticosteroids,[26,27] and an association of osteonecrosis with cumulative steroid dose has been found in a study of 254 steroid-treated patients with confirmed SARS.[28]

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